T4 - Liver

Question 1

Types of hepatitis (5)

Answer 1

Viral
Alcoholic
NAFLD
Drug-induced
Autoimmune

Question 2

The Hepatitis virus that is spread by ingestion?

Answer 2

A and E

Question 3

The hep virus that is spread parenterally?

Answer 3

C

Question 4

The hep viruses that are spread parenteral, sexual contact?

Answer 4

B

Question 5

All hep viruses are tested for using IgM except for?

Answer 5

Hep C

Question 6

Which hepatitis is more high risk in pregnancy?

Answer 6

Hep E

Question 7

IgM is ______ it leaves 6mo after an acute infx.
IgG ___ it will be present after infection.

Answer 7

Immediate.
Stays.

Question 8

Someone who has a negative anti-HBs

Answer 8

Has never had HBV or vaccine - they are susceptible.

Question 9

Someone who has a positive anti-HBs. AND a positive anti-HBc

Answer 9

Is immune to HBV from a natural infection.

Question 10

Anti-HBs positive shows immunity through ______
Anti-HBc positive shows immunity through _____

Answer 10

Vax
Natural infx.

Question 11

If the HBsAg is positive:

Answer 11

The patient has a current acute or chronic HBV infx.

Question 12

POs IgM anti-HBcand negative anti-HBs means

Answer 12

Acute infection.

Question 13

What should you consider before selecting medication to treat HEPC

Answer 13

There are different genotypes of HCV - need to test to see which one to select the best medication to target that specific genotype.

Question 14

Screening for HCV

Answer 14

18 and older - once lifetime
<18 - if risky behavior.
Routine prenatal screening with every pregnancy.
Annual for IV drug users and HIV infected MSM and MSM who take PrEP.

Question 15

_____ % of HCV infections clear, and ______% are chronic.

Answer 15

15-25%
75-85%

Question 16

______% of chronic HCV patients develop cirrhosis over 20 year.

Answer 16

10-20%

Question 17

2 step testing for HCV:

Answer 17

Antibody - negative - no infx
Positive -> HCV RNA -> positive: current HCV infx, Negative, past infx

Question 18

T/F: the gold standard for dx of cirrhosis is liver biopsy and it is always performed.

Answer 18

False.Gold standard IS liver biopsy, but many risks, so alternatives are usually used.

Question 19

Most common Hepatitis causes?

Answer 19

Hep C and alcohol

Question 20

How does a fibroscan work?

Answer 20

It measures the stiffness of the liver to stage the degree of liver fibrosis.

Question 21

Earliest s/s of liver cirrhosis:

Answer 21

Pruritis, wt loss, fatigue, weakness, malaise, dark urine and pale stools.

Question 22

What MELD-Na score do you need to refer for liver transplant?

Answer 22

> 17

Question 23

3 types of HIV testing - which one can give you the earliest recognition?

Answer 23

NAT test - w/in 10-13 days of exposure. The rest are over 18-90 days.

Question 24

interdisciplinary care for patients with HIV

Answer 24

SW, MH, nutrition, substance abuse, dental, ophtho, colonoscopy, mammogram, pap (if age appropriate) and ID.

Question 25

Your HIV + patient presents with oral thrush. What should you do?

Answer 25

Start prophy for pneumocystitis PNA

Question 26

If you patient with HIV has a CD4 ct below 200, then

Answer 26

Start daily Bactrim for infx prophy.

Question 27

In an acute HIV infection, the viral load will be ____ and the CD4 count will be ____. As the acute phase wanes, these levels with alternate. Don’t confusion this _____ CD4 count with the ____ CD4 count in AIDS.

Answer 27

Hight Low Low Low

Question 28

How often do you f/u with patients with HIV?

Answer 28

3-6mo

Question 29

Administer PEP no later than ______

Answer 29

72hours post exposure

Question 30

T/F: PEP is safe during pregnancy

Answer 30

True.

Question 31

Why should you repeat HIV testing in 24weeks for a patient who is co-infected with HepC?

Answer 31

HepC has been shown to delay the HIV sero-conversion.

Question 32

What must you do before starting PrEP?

Answer 32

Documented negative 4th gen HIV test. Rapid HIV POC HIV test negative and no high risk sex 3 weeks prior to starting No s/s of acute HIV infection Normal renal fxn Doc Hep B SAb POs.

Question 33

After starting PrEP, follow up in _____. What should you assess at this f/u visit?

Answer 33

3mo Med adherence, HIV test, behavioral risk support, med SEs, STI s/s, renal fxn, STI test Q6 o.

Question 34

T/F: your patient has been prescribed PrEP. They are protected right after their first dose.

Answer 34

False. PrEP takes 7 days for adequate rectal tissue protection, and 20 days for blood and vaginal tissue protection.